Brick Order Form

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My Gift to the Crex Meadows

Wildlife Education Center

Thank you for considering a gift to the Crex Meadows Wildlife Education Center. We want to make it easy for you and provide you with something to remind you of your gift. We are happy to offer the following items:

**Your name engraved on a brick that will be used to pave the walkway to the building. Bricks come in two sizes; 4x8” and 8x16”. The 4x8” has space for 3 lines of characters

with 14 characters per line and the 8x16” has space for 6 lines with 24 characters per line.

Your gift at the $100, $500, $1,000 and $5,000 giving levels makes you eligible for the items listed below:

Giving level Item

$100.00 One 4x8” brick engraved with your name or message

$500.00 One sharp-tailed grouse print and one 4x8” brick, or one 8x16” brick.

$1,000.00 One 8x16” brick and one sharp-tailed grouse print.

$5,000.00 One 8x16” brick, one sharp-tailed grouse print, and your name

on our Major Donors plaque.

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I would like to make a gift of $___________.

Name_________________________________________________________________________________

Address_______________________________________________________________________________

City________________________ State___________ Zip________________

Tele. No.____________________________________

Method of payment:

__ Check (payable to Friends of Crex)

__ Charge __ Mastercard __ Visa

Account#________________________________________ Expiration _______________

Signature required for charge:________________________________________________

Return to: Friends of Crex, Box 367, Grantsburg, WI 54840

Please print your name or message as it is to appear on the brick

4x8’ BRICK l l l l l l l l l l l l l__l__l

l l l l l l l l l l l l l__l__l

8x16” BRICK l l l l l l l l l l l l l l l l l l l l l l l l l

l l l l l l l l l l l l l l l l l l l l l l l l l

Please place information for additional bricks on a separate piece of paper.

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